Labor is a series of three distinct stages, aptly called first, second, and third stages. For most women the longest span is the first stage, which lasts from the earliest signs of labor right through baby's descent into the birth canal in preparation for stage two — pushing. Stage three consists of delivering the placenta, which mothers usually feel is a cakewalk after all the hard work involved in baby's arrival.

First Stage

The first stage of labor begins with early (or latent) labor and ends with active labor. Your provider probably uses the term transition (or descent) to refer to the end of first stage labor.

During the early phase the cervix effaces (thins) and dilates (opens). This ripening process perhaps started several weeks ago, well before the regular contractions of early labor begin (see Chapter 17). Now your cervix will dilate to about 4 or 5 centimeters. Contractions will arrive every fifteen to twenty minutes and last sixty to ninety seconds. If your partner or coach isn't around, now is the time to contact him so he can be by your side. Then touch bases with your provider, who will tell you at what point you should head to the hospital or birthing facility.

Try to stay up and moving through contractions as much as you can to let gravity help your baby descend. Consider a light liquid snack (for example, broth or juice) to power up your energy reserves for the long road ahead. Rest if possible. Try the breathing and relaxation techniques you picked up in childbirth class as well as the coach-assisted massage or showering to get you through these first few hours. Then leave for the hospital and the next phase — active labor.

In active labor your contractions are coming closer together regularly, perhaps three to five minutes apart, and they can be intense, lasting forty-five to sixty seconds. These strong contractions are dilating your cervix from about 4 to 5 centimeters to around 8.

Once you reach the birthing center or hospital, you'll be quickly prepped as described earlier and given an internal exam to check the progress of your cervix. The baby's position will be checked, and you will probably be hooked up to a fetal monitor to assess the baby's well-being. (Review Chapter 5 for more on fetal monitoring.)

Other signs that active labor is in progress:

Your membranes rupture. If the amniotic sac hasn't already broken, it will now or very soon.

You bleed from your vagina. More of the mucous plug is being expelled.

You need air. Put those cleansing breaths and other breathing techniques into practice. Your hard-working uterus needs oxygen.

Your back really hurts. The baby's head is pushing on your backbone. Massage can help.

You have muscle cramps. Again, massage can help the ill-timed charley horse.

You're exhausted and physically spent. Remember what you're working toward. Let your coach know how you're feeling so she can motivate you and get you whatever she can to keep you moving forward.

Don't feel inadequate or guilty about asking for pain medication at any point if you want it. You wouldn't hesitate to take novocaine if you were getting a wisdom tooth pulled, yet having an eight-pound child pulled through a 10-centimeter opening doesn't qualify? Pain medication is a tool, just like your breathing exercises. Wisely used, it can result in a better birth experience for both you and your child.

Once your cervix reaches 8 centimeters and contractions start coming one on top of another to get you to full dilation, the end of the first stage (sometimes called transition) has arrived. Because of the frequency of contractions and the overwhelming urge to push, this is the most difficult part of labor. Fortunately, it culminates in your child's delivery, once you bridge those final 2 centimeters to become fully dilated.

As you begin to transition from first- to second-stage labor:

You could be nauseous and may even vomit.

You have chills or sweats, and your muscles twitch.

Your back really, really hurts.

Contractions are just minutes apart, if even that.

There is pressure in your rectum from the baby.

You are absolutely exhausted.

You may feel like pushing even though your cervix is not yet fully dilated.

Although every fiber of your body is probably screaming “PUSH!,” you need to hold back just a few moments more. Your cervix is almost, but not quite, open far enough for baby's safe passage. Take quick, shallow breaths and resist the urge to push until your doctor or midwife gives the go ahead.

Second Stage, or PUSH!

Your cervix has made it to 10 centimeters, and you are finally allowed to push. This second stage can last anywhere from a few minutes (with second or subsequent babies) to several hours. Your contractions will still arrive regularly, but they aren't quite as close together — a welcome relief. Pushing is very hard work, but the sensations may change from the intense gripping you've experienced to more of a stinging or burning sensation.

Your birth attendant and/or coach will let you know when the peak of the contraction occurs, the optimum time for pushing effectively. Use whatever it takes to push effectively. If that means moaning, grunting, and emitting other primal sounds that make your prenatal snoring sound like a lullaby by comparison, go for it. The people attending your birth have probably heard just about everything. Don't be embarrassed, because the noise won't even phase them.

The emergence of the head at your vaginal opening starts with a small patch of skin visible during the peak of a push. The patch may recede when you rest but will reappear at the next contraction. Unless your baby is arriving in a breech position, the head will finally crown (or bulge) right out of your vaginal opening. You may be asked to stop pushing momentarily as the baby's head is ready to emerge, in order to prevent perineal tearing. Panting can help you suppress the urge. The obstetrician or midwife may decide on an episiotomy if your skin doesn't appear willing to stretch another millimeter, or she may attempt perineal massage.

Finally the head slides face down past the perineum and is eased out carefully by the birth attendant to prevent injury to the baby. The attendant may wipe the eyes, nose, and mouth and suction any mucus or fluid from her upper respiratory tract. It's all downhill from here as the rest of the body slides out.

As your baby leaves the quiet, dim warmth of the womb for the bright lights and big noises of the outside world, his respiratory reflexes kick in and the newborn lungs fill with air for the first time. He'll probably test out those lungs with a full-fledged wail. Your doctor will place the baby on your stomach for introductions, usually with the umbilical cord still attached.

The cord will continue to pulse with blood flow for a few minutes. The timing of the actual clamping and severing of the cord will depend upon your practitioner, and this is a matter of some debate in childbirth circles. Some professionals believe that waiting until pulsation has stopped or even until after the placenta is delivered improves baby's circulation and blood pressure, reducing baby's risk of early childhood anemia and mom's chance of hemorrhage. Other practitioners still follow the traditional method of clamping and cutting the cord earlier. You may want to talk the issue over with your doctor in advance of delivery day if you have concerns about the timing of the cord cut. If baby requires resuscitation, if the cord is tightly wrapped around a body part or is exceedingly short, it will be cut sooner.

Most practitioners will give dad (or even mom) the option of cutting the cord in an uncomplicated birth. Don't feel bad if it isn't your cup of tea, especially if either one of you is a bit squeamish. Better to spend the time cuddling your baby than being picked up off the delivery room floor.

Some parents choose to bank their child's umbilical cord blood after birth. The umbilical cord blood contains stem cells, those miraculous little blank slates from which all organs and tissues are built. Cord blood collected immediately after birth is placed in a collection kit and flown to a facility where it is cryogenically frozen and banked for later use, if needed. The theory behind cord banking is that if your child ever develops a disease or condition requiring stem-cell treatment, the cord blood can be thawed and used for her treatment. If it matches certain biological markers, cord blood can be used to treat other family members as well. However, banking is cost prohibitive for many and requires an annual storage fee for as long as you'd like to keep the cord blood frozen.

Third Stage, or You Aren't Done Yet!

The third stage of labor is the delivery of the placenta. The entire placenta must be expelled to prevent bleeding and infection complications later on. Contractions will continue, and your doctor may press down on your abdomen and massage your uterus or tug gently on the end of the umbilical cord hanging from your vagina. You might also be injected with the hormone Pitocin (oxytocin) to step up your contractions and expel the placenta. You'll be given pushing directives again, but this part will seem like a piece of cake given the task you've just completed.

Once the placenta is out, any stitches you require to repair tearing or episiotomy incisions will be put in. A local anesthetic will be injected to deaden the area if you aren't still anesthetized from an epidural.